Paul Silverston
Medical students and junior doctors learn how to recognise patterns of illness from textbooks and disease-specific lectures that tend to present illnesses in their established form, when the symptom history, clinical findings and investigations are all positive for that disease. This is further reinforced by seeing patients in hospital clinics and on the wards who have established disease and in whom the diagnosis has often already been made. In primary care, patients often present much earlier in their illness with symptoms and signs that are not disease-specific and yet they may still have a serious illness which has yet to manifest itself through the presence of positive findings in the symptom history, or clinical examination. Medical students and junior doctors on attachments in primary care may not be familiar with the risks inherent in assessing patients during the early stages of a serious illness that they would otherwise be familiar with in its established form and also of the limitations of performing a single point in time clinical assessment during the early stages of an evolving illness. This paper discusses the role that medical educators based within the primary care setting have in teaching medical students and junior doctors about the need to perform a risk assessment
when patients present during the early stages of an illness and the importance of safety-netting these patients, if they are to be managed safely.